Medicaid Access Coverage in 2019 Graphics Featuring Results

Medicaid Access & Coverage in 2019 Graphics Featuring Results from the Institute for Medicaid Innovation’s 2020 Annual Medicaid Managed Care Survey

Comparison of Elements of Medicaid MCO Coverage by Health Plan Size, 2019 Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

Comparison of Elements of Medicaid MCO Coverage by Health Plan Size, 2019 Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

Percentage of Medicaid MCOs Serving Specific Populations, 2019 Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

Percentage of Medicaid MCOs with Special Provider Contracts, 2019 Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

Top 10 Strategies Used by Medicaid MCOs to Recruit and Retain Providers, 2019 Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Pharmacy ] Percentage of Medicaid MCOs Fully at Risk for Pharmacy Health Benefits by Health Plan Size, 2017 -2019 Medicaid MCOs with 250, 000 or fewer covered lives Medicaid MCOs with 250, 001 to one million covered lives Medicaid MCOS with over one million covered lives All Medicaid MCO respondents 2017 100% 57% 75% 69% 2018 86% 80% 100% 89% 2019 100% 83% 100% 93% Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Pharmacy ] 93%of Medicaid MCOs were fully at-risk for pharmacy benefits in 2019. The percentage of MCOs at-risk for 93% pharmacy benefits increased by 24 percentage points from 2017 to 2019. Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Pharmacy ] Most Common Challenges in Managing Prescription Drug Benefits in 2019 Utilization and cost history unknown for new drugs entering a market Increase in number of specialty pharmacy medications Pharmacy benefits or subset of benefits carved out of managed care Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Pharmacy ] Trends in the Most Common Challenges in Managing Medicaid Prescription Drug Benefits from 2017 -2019 Challenges Percentage of Medicaid MCOs in 2019 Utilization and cost history unknown for new drugs entering a market 85% Increase in number of specialty pharmacy medications 77% Pharmacy benefits or subset of benefits carved out of managed care 69% Member comprehension of engagement programs 62% Direction of Change from 2017 - 2019 N/A Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCOMCO Survey Source: Institute for Medicaid Innovation. Annual Medicaid Survey

[ Behavioral Health ] Percentage of Medicaid MCOs at Risk for Behavioral Health Benefits, by Health Plan Size, 2017 -2019 Medicaid MCOs with 250, 000 or fewer covered lives Medicaid MCOs with 250, 001 to one million covered lives Medicaid MCOS with over one million covered lives All Medicaid MCO respondents 2017 50% 71% 100% 77% 2018 72% 80% 100% 84% 2019 80% 67% 75% 73% Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Behavioral Health ] 73%of Medicaid MCOs covered behavioral health services in 2019. The most common barriers to behavioral and physical health integration were access to data between care management and behavioral health teams and system differences with subcontractor. Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Behavioral Health ] Top operational, network, and policy barriers to integrating behavioral and physical health across all three years of the survey (2017 -2019) Operational Access to data between care management and behavioral health teams Policy Network Provider capacity to provide integrated physical and behavioral health at point of care Access to behavioral health providers in select regions (e. g. , rural, underserved) Fragmentation in program funding and contracting for physical and behavioral health services 42 CFR Part 2 limitations on SUD treatment information being shared Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Women’s Health ] Percentage of Medicaid MCOs with Targeted Women’s Health Programs, by Health Plan Size, 2017 -2019 Medicaid MCOs with 250, 000 or fewer covered lives Medicaid MCOs with 250, 001 to one million covered lives Medicaid MCOS with over one million covered lives All Medicaid MCO respondents 2017 100% 86% 100% 92% 2018 86% 80% 100% 89% 2019 100% 83% 100% 93% Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Women’s Health ] 93%of Medicaid MCOs provided targeted women’s health programs in 2019. 100% of health plans indicated that prenatal and postpartum care is a priority and that they have targeted programs and engagement strategies to address this priority. Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Women’s Health ] Most common impact of churn on Medicaid health plans addressing the long-term health of women enrollees from 2017 to 2019 Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ ] Child and Adolescent Health Percentage of Medicaid MCOs Offering Targeted Child Health Programs by Health Plan Size, 2017 -2019 Medicaid MCOs with 250, 000 or fewer covered lives Medicaid MCOs with 250, 001 to one million covered lives Medicaid MCOS with over one million covered lives All Medicaid MCO respondents 2017 100% 86% 100% 92% 2018 86% 100% 95% 2019 100% Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Child and Adolescent Health ] 100%of Medicaid MCOs offered targeted child health programs in 2019. 93% of health plans contracted with a state Medicaid agency to provide coverage for children with special healthcare needs. Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Child and Adolescent Health ] Most Common Priority Topics with Targeted Programs and Engagement Strategies in 2019 1 Children with Special Healthcare Needs 2 Asthma 3 ADD/ADHD 4 Behavioral Health Screening and Treatment Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Child and Adolescent Health ] Most Common Barriers for Medicaid MCOs in Addressing Children with Special Healthcare Needs in 2019 Carved-out services created inefficient services for families Poor communication among multiple providers to families Carved-out services created an increased risk for duplication and costs Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Child and Adolescent Health ] In 2019, 20% of Medicaid MCOs indicated that health disparities impacting sexual and gender minorities were a priority for child and adolescent members 13% offered a targeted program and engagement strategy to address those health disparities 43% of MCOs covered gender-affirming care for transgender and gender-nonconforming children with special health care needs in 2019 Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Managed Long-Term Services and Supports ] 53%of Medicaid MCOs were at-risk for long-term services and supports. 100% of health plans across all three years of the survey (2017 -2019) indicated performing the following core functions in MLTSS care coordination models: • • Conducted risk assessments Engaged a care team of professionals to address the needs of the member Developed a plan of care Supported and encouraged adherence to care plan In addition to supplying the provider directory, supported the member in identifying and connecting with providers Coordinated in-home services Coordinated home and community-based services Transition planning (e. g. , acute care to residential care; residential care to the community) Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Managed Long-Term Services and Supports ] Percentage of Medicaid MCOs at Risk for MLTSS by Health Plan Size, 2017 -2019 Medicaid MCOs with 250, 000 or fewer covered lives Medicaid MCOs with 250, 001 to one million covered lives Medicaid MCOS with over one million covered lives All Medicaid MCO respondents 2017 50% 86% 100% 85% 2018 43% 60% 100% 67% 2019 40% 33% 100% 53% Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Managed Long-Term Services and Supports ] Common Barriers for Medicaid MCOs in 2019 75% Medicaid and Medicare misalignment 63% State program requirements Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Managed Long-Term Services and Supports ] Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Social Determinants of Health ] Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Social Determinants of Health ] The most common populations targeted for social determinants of health programs: Homeless/Housing Insecure (87%) Pregnant individuals (73%) Adults with serious mental illness (67%) Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Social Determinants of Health ] 50% of Medicaid MCOs utilized an internally developed or adapted SDOH screening tool. 13% did not use a screening tool. Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey

[ Social Determinants of Health ] Top barriers to serving member social needs High rate of member churn Unsustainable resources CBO capacity and financial support Inability to pay for non-medical services Source: Institute for Medicaid Innovation. 2020 Annual Medicaid MCO Survey